Department of Urology, Mayo Clinic, Rochester, Minnesota.
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
J Urol. 2018 Sep;200(3):520-527. doi: 10.1016/j.juro.2018.04.069. Epub 2018 Apr 27.
We investigated the incidence and survival impact of symptomatic venous thromboembolism after nephrectomy with inferior vena cava tumor thrombectomy.
We retrospectively reviewed the records of 183 patients who underwent nephrectomy with inferior vena cava tumor thrombectomy (level I-IV) for renal cell carcinoma between 2000 and 2010. Postoperative venous thromboembolism was defined as symptomatic bland thrombus or embolism confirmed on imaging. The cumulative incidence of venous thromboembolism was estimated by the Kaplan-Meier method. Associations of clinicopathological features with time to thromboembolism after surgery and all cause mortality were evaluated on multivariable analysis with Cox models.
Symptomatic venous thromboembolism developed in 55 patients a median of 23 days (IQR 5-142) postoperatively, including pulmonary thrombosis in 24, deep venous thrombosis in 17, bland inferior vena cava thrombosis in 13 and portal vein thrombosis in 1. The cumulative incidence of thromboembolism 30, 90 and 365 days following surgery was 17%, 22% and 27%, respectively. A history of smoking (HR 2.15, 95% CI 1.09-4.24, p = 0.028), ECOG (Eastern Cooperative Oncology Group) performance status 1 or greater (HR 2.15, 95% CI 1.17-3.93, p = 0.013), hypercoagulability disorder (HR 5.12, 95% CI 1.93-13.59, p = 0.001) and bulky lymphadenopathy at surgery (HR 4.84, 95% CI 1.87-12.51, p = 0.001) was significantly associated with an increased risk of venous thromboembolism on multivariable analysis. Postoperative venous thromboembolism was significantly associated with an increased risk of all cause mortality (HR 1.53, 95% CI 1.04-2.23, p = 0.029).
Venous thromboembolism after nephrectomy and tumor thrombectomy is common within 90 days of surgery. Symptomatic venous thromboembolism in this population is independently associated with a greater risk of mortality.
我们研究了肾细胞癌患者行肾切除术联合下腔静脉肿瘤栓子切除术（肿瘤栓子位于 I-IV 级）后症状性静脉血栓栓塞的发生率及其对生存的影响。
我们回顾性分析了 2000 年至 2010 年间 183 例行肾切除术联合下腔静脉肿瘤栓子切除术（肿瘤栓子位于 I-IV 级）治疗肾细胞癌的患者的记录。术后静脉血栓栓塞的定义为影像学证实的有症状的单纯性血栓或栓塞。通过 Kaplan-Meier 法估计静脉血栓栓塞的累积发生率。采用多变量 Cox 模型对临床病理特征与术后血栓栓塞时间及全因死亡率之间的关系进行评估。
术后中位 23 天（IQR 5-142）时 55 例患者出现症状性静脉血栓栓塞，其中 24 例为肺血栓形成，17 例为深静脉血栓形成，13 例为单纯性下腔静脉血栓形成，1 例为门静脉血栓形成。术后 30、90 和 365 天的血栓栓塞累积发生率分别为 17%、22%和 27%。吸烟史（HR 2.15，95%CI 1.09-4.24，p=0.028）、ECOG（东部肿瘤协作组）体力状态 1 或更高（HR 2.15，95%CI 1.17-3.93，p=0.013）、高凝状态（HR 5.12，95%CI 1.93-13.59，p=0.001）和手术时大的淋巴结病变（HR 4.84，95%CI 1.87-12.51，p=0.001）与多变量分析中静脉血栓栓塞风险增加显著相关。术后静脉血栓栓塞与全因死亡率增加显著相关（HR 1.53，95%CI 1.04-2.23，p=0.029）。
肾切除术联合肿瘤栓子切除术术后 90 天内静脉血栓栓塞很常见。该人群中症状性静脉血栓栓塞与更高的死亡率独立相关。
